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Background: Occurrence of right atrial masses, especially in patients with history of cardiac surgery, is rare. Differential diagnosis between malignant and non-malignant aetiologies might be cumbersome, and surgery is often required to prevent complications or disease evolution. Case: We report the case of a 16-year-old girl from a rural area of Sudan, who underwent surgery for a modified De Vega’s tricuspid annuloplasty, and mitral and aortic valve replacement with mechanical prostheses. The patient was on regular follow-up but demonstrated a poor compliance to anticoagulation therapy with a time in therapeutic range between 52% and 20%. She remained asymptomatic, but a right atrial mass was diagnosed by transthoracic echocardiography during a follow-up visit 41 months after the first operation. Surgical removal of the mass revealed an organized thrombus arising from the point where the Prolene stitches for the tricuspid annuloplasty were previously passed. The patient recovered from surgery, was discharged home on post-operative day 10 and the first follow-up visit at 30 days after discharge confirmed a good clinical status and a normal transthoracic echocardiography (TTE). Conclusions: This case report describes the diagnostic and therapeutic work-out of a thrombus formation on the suture lines of a tricuspid annuloplasty. Moreover, it highlights the importance of a strict and long follow-up after valvular surgery and of the adherence to anticoagulation therapy, especially for patients living in rural areas of developing countries.

Pancreatic beta cells (β-cells) differentiate during fetal life, but only postnatally acquire the capacity for glucose-stimulated insulin secretion (GSIS). How this happens is not clear. In exploring what molecular mechanisms drive the maturation of β-cell function, we found that the control of cellular signaling in β-cells fundamentally switched from the nutrient sensor target of rapamycin (mTORC1) to the energy sensor 5'-adenosine monophosphate-activated protein kinase (AMPK), and that this was critical for functional maturation. Moreover, AMPK was activated by the dietary transition taking place during weaning, and this in turn inhibited mTORC1 activity to drive the adult β-cell phenotype. While forcing constitutive mTORC1 signaling in adult β-cells relegated them to a functionally immature phenotype with characteristic transcriptional and metabolic profiles, engineering the switch from mTORC1 to AMPK signaling was sufficient to promote β-cell mitochondrial biogenesis, a shift to oxidative metabolism, and functional maturation. We also found that type 2 diabetes, a condition marked by both mitochondrial degeneration and dysregulated GSIS, was associated with a remarkable reversion of the normal AMPK-dependent adult β-cell signature to a more neonatal one characterized by mTORC1 activation. Manipulating the way in which cellular nutrient signaling pathways regulate β-cell metabolism may thus offer new targets to improve β-cell function in diabetes.

We have tested different preparation and photographic methods to define a protocol for UV analysis of fossil specimens. We also have explored its main applications while analysing specimens from different stratigraphic contexts, of different biomineralogical composition, and belonging to different fossil groups (including invertebrates and vertebrates). We have photographed specimens using a camera equipped with appropriate lens and filters both in visible light and with flashlights at two wavelengths: the 365 nm UV light and the 440 nm visible violet spectrum, the latter here tested for the first time. Our results indicate that bleach treatment is not recommended for calcite-shelled brachiopods, while it is suggested for aragonite-shelled molluscs. We show that photography in the ultraviolet and visible violet spectra are useful tools enhancing the recognition of morphological characters and colour patterns and allowing to distinguish soft-bodied fossils from the matrix. Also, it allows to discern specimen areas embedded in the sediment from those exposed to sunlight, which is helpful to reconstruct the conditions experienced by fossils. However, the mineralogy of the biomineral affects UV responses, as morphological characters of calcite shells are better emphasized with the 440 nm wavelength (visible violet spectrum), whereas those of aragonite, bioapatite and phosphatized specimens with the 365 nm (ultraviolet spectrum); also, shell microstructures with their different crystal arrangement and elemental incorporation may cause different reactions, whereas the stratigraphic context affects specimen preservation influencing pigment preservation. We thus provide a protocol for photography in the ultraviolet and visible violet spectra and show that this technique has a high potential in palaeontology, having no limitations for its application in invertebrate or vertebrate specimens.

Historical simulation games, an entertainment activity of high cultural and educational value, have been recognized as an useful research tool, as well as an innovative teaching support. Medieval military history, in which warfare assumes the features of a “game” or “ludus” regulated by codified rules and behaviours, lends itself to be interpreted through the techniques typical of simulation games. This article wants to show which results can be obtained with this new method and approach, mentioning different titles of games published in the last years.

The use of immune checkpoint inhibitors (ICIs) for treating several types of cancer is increasing, but they may be associated with immune-related adverse events (irAEs). Pancreatitis is a rare irAE, mostly responsive to steroid treatment. There are no published data on the management of steroid-refractory ICI-induced pancreatitis. Rituximab has shown efficacy in the setting of relapsing non-ICI-induced autoimmune pancreatitis. However, its use has not been tested for treating immunotherapy-related pancreatitis. Here, we present the case of a patient with steroid-refractory immune-related pancreatitis successfully treated with rituximab as a potential strategy for irAE management.

La cirugía para la enfermedad obstructiva del tracto de salida del ventrículo izquierdo con enfermedad de la válvula aórtica e hipoplasia del anillo aórtico continúa siendo un reto. Se han descrito diversas técnicas quirúrgicas para la ampliación del anillo aórtico, de las cuales el procedimiento de Konno-Rastan es una opción atractiva; sin embargo, no es muy frecuente realizarla debido a su alto grado de dificultad. Se presenta el caso de una paciente femenina, de 15 años de edad, con diagnóstico de estenosis valvular aórtica grave e hipoplasia del anillo aórtico, a quien se le realizó ampliación del anillo aórtico con técnica de Konno-Rastan y reemplazo valvular aórtico.

Background: Occurrence of right atrial masses, especially in patients with history of cardiac surgery, is rare. Differential diagnosis between malignant and non-malignant aetiologies might be cumbersome, and surgery is often required to prevent complications or disease evolution. Case: We report the case of a 16-year-old girl from a rural area of Sudan, who underwent surgery for a modified De Vega’s tricuspid annuloplasty, and mitral and aortic valve replacement with mechanical prostheses. The patient was on regular follow-up but demonstrated a poor compliance to anticoagulation therapy with a time in therapeutic range between 52% and 20%. She remained asymptomatic, but a right atrial mass was diagnosed by transthoracic echocardiography during a follow-up visit 41 months after the first operation. Surgical removal of the mass revealed an organized thrombus arising from the point where the Prolene stitches for the tricuspid annuloplasty were previously passed. The patient recovered from surgery, was discharged home on post-operative day 10 and the first follow-up visit at 30 days after discharge confirmed a good clinical status and a normal transthoracic echocardiography (TTE). Conclusions: This case report describes the diagnostic and therapeutic work-out of a thrombus formation on the suture lines of a tricuspid annuloplasty. Moreover, it highlights the importance of a strict and long follow-up after valvular surgery and of the adherence to anticoagulation therapy, especially for patients living in rural areas of developing countries.

INTRODUCTION To ensure the continuity of nutritional care in Cardiovascular Rehabilitation (CR) during the COVID-19 epidemic emergency, a toolkit for telenutritional follow-up was developed for patients at nutritional risk and patients with modifiable risk factors related to eating habits. The reference method for this work is represented by the Nutrition Care Process and Terminology by the Academy of Nutrition and Dietetics (AND), which pursues the goal of implementing safe, effective, person-centred, timely, efficient and equitable nutritional care. MATERIALS AND METHODS The toolkit is composed of digital records for nutritional teleconsultation aimed at the most fragile (at risk for malnutrition), or overweight/obese, diabetic, dyslipidemic, hypertensive patients. In addition, it provides tools and educational/informative material useful to patients for carrying out the telephone consultation/video call. CONCLUSIONS This work - and telenutrition in general - could optimize the effectiveness of nutritional care and patient’s adherence, by reducing distances, waiting times, costs and other inconveniences. Our future goal is to develop a research project involving CR centers to establish the effectiveness of using the toolkit in clinical practice, in terms of desired outcomes and follow-up dedicated time.

INTRODUZIONE Per garantire la continuità dell’assistenza nutrizionale in Riabilitazione Cardiologica (RC) durante l’epidemia da COVID 19, è stato elaborato un toolkit per il teleconsulto nutrizionale, rivolto a pazienti con fattori di rischio modificabili correlati alle abitudini alimentari ed a pazienti a rischio nutrizionale. Il metodo di riferimento del presente lavoro è quello del Nutrition Care Process Terminology dell’Academy of Nutrition and Dietetics (AND), che persegue l’obiettivo di implementare un’assistenza nutrizionale sicura, efficace, centrata sulla persona, tempestiva, efficiente ed equa. MATERIALI E METODI Il toolkit è composto da cartelle nutrizionali elettroniche per il follow-up telematico rivolte ai pazienti più fragili (a rischio di malnutrizione), o in sovrappeso/obesi, diabetici, dislipidemici, ipertesi. Inoltre, sono stati creati strumenti e materiale didattico informativo utili ai pazienti per lo svolgimento del consulto telefonico/videochiamata nutrizionale. CONCLUSIONI Il ricorso al teleconsulto potrebbe ottimizzare l’efficacia dell’assistenza nutrizionale e l’aderenza dei pazienti, tramite una riduzione delle distanze, dei tempi di attesa, dei costi e dei disagi in generale per i pazienti stessi. La nostra prospettiva è quella di sviluppare un progetto di ricerca presso i Centri di RC per stabilire l’efficacia dell’utilizzo del toolkit nella pratica clinica in termini di outcome desiderati e di tempo dedicato al follow-up dei pazienti.

The media hold an essential role in circulating information, disseminating knowledge, constructing representations, shaping ideologies, and influencing contemporary societies. Since the outburst of the coronavirus (Covid-19) pandemic, their attention has been mostly paid to the protection and the health situation of citizens worldwide. Although millions of refugees are also exposed to a new risk with their vulnerable position being deteriorated, the refugee issue in the context of the Covid-19 pandemic seems to have been downgraded. In this regard, the current article explores to what extent the refugee issue was salient in the Greek, German, and British press during the pandemic. At the same time, it looks at how the media outlets in all three countries addressed it, focusing on the key topics reported and the interpretive schemata of the pertinent coverage. We use a qualitative content analysis, examining a sample of newspaper articles that were published between 1 January 2021 and 1 May 2021. The results presented by this article suggest that the epidemiological developments or other health aspects related to local populations seem to overshadow the situation of refugees. Yet, media outlets mostly perceive refugees as victims of the pandemic, underlining their vulnerability and marginalisation in health, economic, and education terms. The findings seek to feed the public discussion, providing a fruitful approach to the media narratives and representations of refugees during the Covid-19 crisis.

Abstract Background The SARS-CoV-2 outbreak pushed the Italian government to start a strict lockdown, replacing school attendance with long-distance learning. This caused reduced exposure to sunlight but increased exposure to screens. Vernal keratoconjunctivitis (VKC) is a chronic inflammatory ocular condition in which exposure to light plays a cardinal role. We conducted an online survey to evaluate the impact of screen exposure on children with VKC during the COVID-19 lockdown. Methods We performed a survey-based observational study, asking patients followed at the Allergology clinics of Meyer Children’s University Hospital in Florence and of Policlinico Umberto I in Rome to provide grading on 6 subjective ocular clinical manifestations presented during the lockdown and to give an estimate of their hours/day of screen exposure. Results Mean scores of signs and symptoms increased homogeneously when studying patients exposed to longer screen time. When comparing scores collected in 2019 to those in 2020, there was not a significant reduction in clinical manifestations, although the situation differed between the two centers due to geographical differences in sunlight exposure. Conclusion During the lockdown, there was a reduction in sunlight exposure but conversely an increase in the time spent in front of screens that correlated with the worsening of VKC signs and symptoms in direct proportion to the hours/day of screen exposure. Our results also showed a statistically significant difference in the relative impact of long-distance learning on VKC clinical manifestations in the different Italian regions.

Tantrum, merupakan luapan emosi tidak terkontrol pada anak ditunjukkan dengan menangis keras, berteriak, menjerit, memukul, menggigit, mencubit, menendang, berontak, melempar badan ke lantai dan berlari menjauh. Normalnya tantrum terjadi 30 detik sampai 2 menit. Orang tua sering menerapkan strategi yang salah, apabila perilaku tantrum pada anak terlambat untuk ditangani perilaku tantrum akan menjadi sifat yang menetap sampai dewasa. Tujuan pengabdian masyarakat ini meningkatkan pengetahuan dan ketrampilan mengatasi tantrum anak, metode pengabmas adalah riset aksi berbasis penelitian melalui pelatihan dengan sasaran ibu balita dan kader posyandu. Hasil pelatihan didapatkan 41 peserta nili pengetahuan pretest sebagian besar kurang dan post test sebagian besar baik, nilai ketrampilan setelah pelatihan sebagian besar baik. Kesimpulan pelatihan mengatasi tantrum anak pada ibu balita berhasil meningkatkan pengetahuan ibu tentang tanrum dan mampu membantu ibu mengatasi anak saat tantrum.

Introduction: The sodium/iodide symporter (NIS) mediates active iodide accumulation in the thyroid follicular cell. Biallelic loss-of-function variants in the NIS-coding SLC5A5 gene cause congenital dyshormonogenic hypothyroidism due to a defect in the accumulation of iodide, which is required for thyroid hormonogenesis. Objective: We aimed to identify, and if so to functionally characterize, novel pathogenic SLC5A5 gene variants in a patient diagnosed with severe congenital dyshormonogenic hypothyroidism characterized by undetectable radioiodide accumulation in a eutopic thyroid gland, as well as in the salivary glands. Methods: The coding region of the SLC5A5 gene was sequenced using whole-exome sequencing. In silico analysis and in vitro functional characterization of missense SLC5A5 gene variants were performed. Results: Proposita's whole-exome sequencing revealed a novel pair of compound heterozygous missense variants in the SLC5A5 gene, c.1,627G>A (p.G543R) and c.1,684T>A (p.L562M). The parents were heterozygous carriers of the variants as determined by Sanger sequencing of the SLC5A5 gene. The p.G543R variant in the homozygous state has previously been associated with congenital hypothyroidism. The novel p.L562M variant was not reported in the Genome Aggregation Consortium dataset. In silico analysis of the pathogenic impact of the p.L562M variant yielded inconclusive results. Functional in vitro studies showed that the p.L562M variant reduces iodide accumulation due to defective expression of the mutant NIS protein at the plasma membrane. Notably, the aliphatic residue Leu at position 562 in the carboxy terminus of the protein, which is highly conserved in NIS orthologues, is required for NIS plasma membrane expression. Conclusions: We report novel compound heterozygous missense SLC5A5 gene variants causing defective iodide accumulation, thus leading to congenital dyshormonogenic hypothyroidism. [ABSTRACT FROM AUTHOR]

Although body weight (BW) and body surface area (BSA) are utilized to establish the appropriate dosage of anticancer drugs, their distribution in cancer patients is poorly studied, making it challenging to predict the amount of drug use and related costs of BW or BAS-dosed regimens. This study investigates the distribution of BW and BSA in adults with selected cancers who initiated systemic anticancer treatment in the eastern Emilia-Romagna region hospitals between 2011 and 2021. BW and BSA were collected at the first cycle of each new treatment line, with multiple measurements for patients receiving various treatments or treating for other primary malignancies. Results were grouped by sex, tumor site and treatment setting, and the normal distribution hypothesis was tested for each group. Both linear regression model and quantile regression at the 50th, 25th and 75th percentiles were run to explore the factors influencing BSA. The analysis included 20,634 treatment lines and the corresponding BW and BSA measures from a sample of 13,036 patients. The average BW was 68.05kg (64.20kg for females and 75.07kg for males) and the average BSA was 1.76m2 (1.66m2 for females and 1.87m2 for males). In women, the highest BW was in breast and colon groups, while in men, it was associated with prostate and rectum cancers. The model indicated significant association between BSA, age, sex and tumor localization. Notably, stomach and lung cancers were linked to lower BSA for both sexes (for females -0.081 and -0.041m2 respectively compared to those with breast cancer). Advanced settings were related to lower BSA than neoadjuvant treatment, especially for stomach cancer patients, who experienced a weight loss of 3 to 6kg as therapy progressed. The regression models for predicting BSA can assist regulatory bodies in determining reimbursement for new chemotherapy drugs and help hospitals forecast drug utilization and expenditure more accurately. [ABSTRACT FROM AUTHOR]

By demonstrating that extensional inheritance plays a decisive role in the formation of orogens, recent studies have questioned the ability of a unique, complete Wilson cycle model to explain the diversity of collisional orogens. For 5 years, the OROGEN Research Project had therefore the ambition to challenge this classical Wilson cycle model. By focusing on the diffuse Africa-Europe plate boundary in the Biscay-Pyrenean-Western Mediterranean system, the project questioned the preconceived “Orogen singularity” assumption and investigated the role of divergent and convergent maturities in orogenic and post-orogenic processes. This work led us to rethink the development of collisional orogens in a genetic (or process-driven) way and to propose an updated version of the ” classical Wilson cycle”, the Wilson Cycle 2.0, and the ORO-Genic ID concept presented in this paper. The particularity of the Wilson Cycle 2.0 is to take into account the divergence and convergence maturity reached during extensional and orogenic processes in proposing different tectonic tracks associated with different ORO-Genic ID numbers. The ORO-Genic ID is composed of a letter (or track), corresponding to the maturity of divergence reached and a number corresponding to the maturity of convergence reached during the formation of the orogen. This new concept relies on the observed pre- and syn- convergent tectono- stratigraphic and magmatic record and deformation history and can be identified in using diagnostic criteria presented in this paper. It represents therefore a powerful tool that can be used to characterize the evolution and the architectural type of an orogenic system. Moreover, as a mappable concept, it can be easily used worldwide and can help us to explain differences in the style of deformation at crustal scale between orogens.

Physical activity in the form of “active breaks” can be combined with academic instruction in primary school. However, few studies have examined the feasibility of conducting active breaks in secondary school. To address this gap, we conducted focus groups (FGs) regarding the implementation of an active breaks (ABs) protocol with 20 teachers and 10 secondary school students. Barriers/facilitators toward the implementation of ABs were classified using grounded theory inductive methods framed by the socio-ecological model. Individual-level factors were instrumental for both teachers and students. Teachers highlighted personal fears and concerns regarding using ABs, while students reported fears related to peer behaviour during the activity. Both teachers and students agreed that ABs can improve cognitive skills and time-on-task behaviour. Teachers articulated concerns related to student behaviour during ABs including possible social exclusion and injury. Students felt that ABs might affect classroom management and interfere with maintaining students’ academic focus. Teachers underscored that ABs required social support from the administration and colleagues. Students felt that ABs could support teachers’ instructional focus and provide them with an energy respite. Collectively, the FGs suggested that environmental limitations could hinder the implementation of ABs. Involving teacher and student feedback during the codesign phase can rationally inform the design of school-based ABs.

Tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide and pulmonary TB (PTB) is the main variant responsible for fueling transmission of the infection. Effective treatment of drug-susceptible (DS) TB is crucial to avoid the emergence of Mycobacterium tuberculosis-resistant strains. In this narrative review, through a fictional suggestive case of DS PTB, we guide the reader in a step-by-step commentary to provide an updated review of current evidence in the management of TB, from diagnosis to post-treatment follow-up. World Health Organization and Centre for Diseases Control (CDC) guidelines for TB, as well as the updated literature, were used to support this manuscript.

Hyperextended rift systems are characterized by extreme crustal thinning and mantle exhumation associated with extensional detachment faults. These faults cut through thinned continental crust, reaching the underlying mantle and allowing for seawater to infiltrate and react with the crustal and mantle rocks. Hydrothermal fluid systems linked to detachment faults result in fluid–rock reactions occurring along the detachments, resulting in the breakdown and alteration of minerals, loss of elements and strain weakening in both mantle and crustal rocks. We present new geological observations and geochemical data from the modern Iberia and fossil Alpine Tethys Ocean Continent Transition and the West Pyrenean Mauléon hyperextended rift basin. We show evidence for a km-scale fluid flow along detachment faults and discuss the conditions under which fluid flow and mass transfer occurred. Convective fluid systems are of major importance for mass transfer between the mantle, crustal and marine reservoirs. We identified gains in Si, Mg, Fe, Mn, Ca, Ni, Cr and V along extensional detachment faults that we relate to channelized, hydrothermal crust- and mantle-reacted fluid systems migrating along detachments in the hyperextended continental crust. The observation that fault rocks of extensional detachment and syn-extensional sedimentary rocks are enriched in mantle-derived elements such as Cr, Ni and V enables us to define the pathways of fluids, as well as to estimate their age relative to detachment faulting and sedimentation. Because all three examples show a similar mass transport of elements along detachment systems at km-scale, we conclude that these examples are linked to convective fluid systems that may affect the thermal state of the lithosphere, as well as the rheology and chemistry of rocks in hyperextended systems, and may have implications for ore mineral exploration in hyperextended rift systems.